About us:

Fallon Health is a company that cares. We prioritize our members--always-making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, we deliver equitable, high-quality coordinated care and are continually rated among the nation’s top health plans for member experience, service, and clinical quality.

Fallon Health’s Summit ElderCare® is a Program of All-Inclusive Care for the Elderly–PACE for short. PACE, an alternative to nursing home care, is a program that helps people 55 and older continue living safely at home. At Fallon Health, we believe our individual differences, life experiences, knowledge, self-expression and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status and other characteristics that make people unique. 

Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE— in the region. 

Brief summary of purpose:

The Clinical Quality Nurse is accountable for the reporting of clinical quality data, data collection, and data analysis.  Projects may include medical record data abstraction, quality of care reviews, grievance and incident investigation or quality initiatives.  This role provides clinical expertise, technical support and data analysis for departmental initiatives and the Quality Services program structure. 

Clinical quality assurance program support

• Perform case reviews on medical records to identify quality of care or substandard care
• referred from incident reports, grievances, etc.
• Assist in the planning, organization and direction of the quality assessment performance improvement program and related activities.
• Assist in the evaluation of programs and implements changes as necessary to improve programs and assure compliance with regulatory requirements.
• Provide support with administrative functions such as form completion, writing reports, and submissions to management and/or appropriate agencies as required.
• Assist in the investigation of incidents, injuries, abuse, etc.  Summarize findings and file reports to appropriate staff and agencies

Data Management, analysis, and reporting

• Oversee maintenance of  clinical logs to manage data that supports clinical quality improvement, actvities HPMS reporting and other external reporting requirements.Analyse clinical tracking logs and monitor for patterns and trends requiring corrective actions.
• Assist in developing annual auditing schedules for departments as well as audit development when identified.
• Coordinate studies peformed within the quality assessment performance improvement program and prepares reports  as required.

Provides training and project management

• Assist in the development and delivery of educational programs revolving around all components of quality assessment performance improvement , including orientation for employees and programs to address the quality assessment process and regulatory guidelines.
• Assist PACE organization sites in developing indicators and follow up procedures for identified problems
• Other duties as necessary

Qualification Requirements: 

Education

Degree in nursing (Bachelors) with a current MA nursing license

License/Certification:

RN

Experience: 

• 5 years related experience in a healthcare setting preferably with a geriatric population
• Quality management/ performance improvement experience preferred
• Knowledge of quality assessment and performance improvement  procedures

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Pay Range Disclosure:
In accordance with the Massachusetts Wage Transparency Act, the pay for this position is$ 100,000-$ 104,000 annually which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.